Surgical instrument



April 15, 1930. H. N. STEVENSON SURGICAL INSTRUMENT Filed Sept. 5, 1929 INVENTOR. 464M 4! JW BY 2E z '5 ATTORNEYS.

= seems partitions Patented Apr. 15, 1930 PAT oFFicE HOLLAND N. STEVENSON,

OF PELHAM, NEW YORK SURGICAL rnsrnumnnr Application filed September 5, 1929. Serial No. 330,601.

This invention relates to an improved instrument for operations on thin osseous tissue in interior body portions inaccessible for open operation and particularly for nose opera- *5 tions; In operations on the interior nose passagesit is frequently necessary for the reinoval of diseased matter to get access to in fected cavities which lie near these interior passages and are separated from them by os- The usual practice, up to the present time, in sinus trouble for example, has been to first pierce or prick such partitions bymeans of a pricking tool and then widen the prick hole with cutting instru- OPenatihg method is objec'tionable for several reasons. The chan e from one instrument to others causes: delay of the operation 'wliich'for surgical and other reasons should be performed as quickly as ma .;by e p y pricliingtool is small and ip'rovide's a cor "start for the ensuing cutti g actions. uch thin Bonyltissue is very liable to tear and bend away in the Widening operation of the primary hole, a conditionwhi'ch is frequently aggra'vated by an infection 'of the bone and periosteunr'rtself resulting in a swollen or softened condition so that there is a strong tendency ofsucli portionsto avoid the action of a blade or some similar operating tool and to resist any attempts of quickly removing them. For these reasons it is almost impossibl'e in most cases to provide a clear-cut opening in such ,Walls; at all events, it requires much skill and effort and time, and renders the draining and cleaning of such cavities very wearisome and not always perfectly reliable. p I

In order to overcome these deficiencies of the hitherto employed procedure I have con ceived a new instrument which is to be used as a combined piercing and punching tool.

The object of the invention is to provide a tool for operationsof the kind stated before which allows the operator in quick succession to' first prick a hole in a comparatively thin bony wall'and then widen it by an action of substantially punching nature without leaving indentations or loose fringes. By

this tool the operator may form either the finally desired opening or provide one to serve as a wide enough primary hole for the further remci'al of wall portions by other instruments. The latter or additional removal of wall portions is greatly facilitated b the sufficient and clean-cut nature of the original opening made by my tool.

In the followin detailed description of the instrument reffirence will be hadto the accompanying drawing. v a

Fig. 1 is a side elevation of the completely assembled instrument in one operating size, comprisin the frame, the outer operating handles, the intermediate connecting portions, and the operating tool proper;

Figs. 1 and 1" represent detacheddetails of F ig. l; v r

Fig. 2 is an enlarged cross-section on' line 22 of Fig. 1;

Fig. 3 is an enlarged longitudinal. cross section of the operating tool proper;

Fig. t is a side elevation of the detached operating blade;

F ig. 5 is a transverse; cross-section ofthis blade on line 55 of 4;

Fig. 6 isa top plan view of the frameend portion with the blade removed;

Fig. 7 is a transverse cross-section throu the frame end portion substantially on [me 77 of Fig. 6; and

Fig. 8 is a transverse cross-section through the same 011 line 88 of Fig. 6.

As will he noted from Fig. 1 the instrument as shown in its preferred formis composed of four parts or elements which are movably linked with each other. The frame with its handle 1, thumb grip 2, intermediate sheath portion 7, and terminal portion 10 gives the necessary rigid support for the remaining parts, which are the operating haudle 20 with finger grip 22 the operating rod 30, and the operating blade 40.

The terminal portion 10 and part of the sheath and rod adjacent to it are so shaped that they can be introduced into the nostril of a patient. The instrument may be manipulated by swinging the operating handle 20 about its fulcrum 3 on the frame, reciprocating movements may be imparted to the operating rod 30 through the pivot pin which,

- gradually 40 (see Figs. 3,

in turn, cause corresponding opening and closing movements of the blade 40 about its pivot 9 with respect to the blade-receiving frame portion 10, so that this portion and the blade may be said to form a shears-like tool. To start the operation, the instrument is inserted and brought in the right position with the blade closed. After the blade has been opened (for instance to a position as shown in Fig. 1), the prick hole is made by using the frame as a handle for depressing the pointed end of the blade.

Before describing the particulars of the blade, its coacting frame portion and the further cooperation of these parts, some other details of construction will be pointed out.

The screw 4 in the frame provides an adjustable stop position for the projection 21 of the operating handle and thereby for the handle -20 itself,iand make s it possible to so adjust the'instrument that'the blade 40 is in a desired angular relation to the axis of the operating rod 30 when the two handles-are held in extreme straddling position (this blade position need not necessarily be the right angle position as shown in Fig. 1).

Theoperating handle 20 (see 1 terfminates in two prongs 23 which hold the pin 24 between theml' YThe end of the operating 'rod engages this pin by means of a slot so .that a sliding pi'votj connection between the rod and the"handle'isobtained. i

p In order to hold the rod down in its guide or sheath7, a head screw 31 (see also Fig. 1") attached to the rod slidingly engages a slot 5 of tliefframe. The slot terminates in a wider end portion 6 which, for disassembling "and cleaning'purposes, permits the screw head to pass through. Fig. 2 shows how the rod is supported in the intermediate or sheath portion 7 of the frame. The blade mating frame portion 10 (see Figs. 3, 6, 7 and 8) may be made integral with the frame or jointed to it by welding, soldering, or in some other suitable man ner. It forms a centrally apertufed, tapering frame end portion with transversal wall at 11 and side walls 12, which latter are circularly extended upwardly at 13 and then fall off to the contour of the sheath. The upwardly extending portions 13 carry two concentrically situated pins 15 attached to them by riveting or in some other Way. These pins form the bearings for the blade 4 and 5). The bearing portion 41 of the blade is provided with two lateral notches 42 which engage the pins 15 as ivots. A centrally located notch 43 on this hearing portion permits the ball-shaped end 32 of the operating rod 30 to freely turn the blade about its pivots. The bearing portion extends in the spoon-shaped blade portion which comprises a bottom 48 tapering in the pointed end 44 and two upwardly curved marginal portions 45. The contour of these side portions near the pivotal end of the blade substantially conforms to the circular Shape of the enlarged side walls 13 of the frame end. These upstanding marginal portions have edges formed with sharpened teeth at he pivotal end 47 and on intermediate portions 46 as well.

It will be understood now that the blade and its companion frame end portion will coact much in the fashion of a die and a matrix. The companion frame 10 conforms closely to the contour of the blade so that the outer edges of the blade all along the portions 44, 45, 46, and 47 cooperate with the cor responding inner edges of the frame as shear ing edges that define a punching area. In other Words, after the primary prick hole has been made with the blade in its upstanding position, asshown in Fi 3, the surgeon closes the operating hand es and thereby moves the blade towards theframe in closing position with the effect that a portion of the bony wall corresponding to the inner area of the frame aperture is punched out.

The severed tissue will be received and held within the frame walls, and its easy and sa fe removal is thus secured.

T he operation and advantage of my in strument ought now to be clearto one skilled in the art from the foregoing description. The instrument disclosed isIth'e first one known to me that is constructed both for originally piercing the osseous'tis'sue (of the nose for example, inmaking a drain for the sinus cavity) and for punching an opening in' th'e wall. Ordinarily, one instrument is inserted for the piercing of the walland then one or more are successively inserted to make the opening. By changing instruments the surgeon has lost exact registration'or contact with the tissue and in actual practice this has led to a lot of difiiculty. But with .the new instrument the original wall piercing action is accomplished byblade 40, and the .same blade will still be in the best possible contact and position and without delay is then swung down on frame 10 to punch an opening in the Wall. An opening punched in this way ordinarily has sharper and better defined walls than can be uniformly produced by any other method or skill that I know about. With a clean hole of the nature described, the drain from the sinus cavity may frequently be sufficient without'any enlargement. But often enlargement is necessary. When it is, the ordinary unching instruments may be. used, as known by the surgeon, and with better. effect because he can proceed with swiftness and certainty-that he has only a clean-cut hole to enlarge. In the old practice much time and skill has been consumed in trying to make certain that the enlarged hole was not made by a bending back of the walls without cutting them. The osseous tissue of the nose has been extremely difiicult to Work upon, on acmost inaccessible cavity count of its tendency, to move away from the instruments and later move back and partially close the opening. Of course the alposition and the difficulty of knowing'the exact nature of the work done by instruments heretofore used presented one of the problems of this invention. I have found from observation of actual cases that it is extremely important to makecertain of a clean-cut opening through the sinus wall and with sucha start the proper draining of the cavity.isgreatly simplified. That is one definite objective of prime importance as a feature of the present invention.

= In order to facilitate the severing of these portions and to assist the punching effect of the instrument, I prefer to provide the sawhke indentations or teeth, which render the action quite reliable by a combination of punching and cutting effect- Another definite feature of my invention, thoughof somewhat lesser im ortance, is the principle of mechanical linliage that I have employed throughout in the assembly of the instrument. All the fulcrums of the instrument consist of pivot elements that can freely he slid in and out of engagement with their bearingelement in a transverse direction with respect to the pivotal axis; while, aslong as the instrument is in; its operative positions, there is no danger ofseparation of the various elements. The same principle is applied to the rod and sheath member. Thistype ofkinematic linkage has two great advantages in the surgical art. Fulcrums, for instance. consisting of a pivot and a cylindrical bearing surface of axially sliding engagement, represent by theirvery nature favorable conditions for the development of germs. A thorough cleaning of such portions is difficult and mreliable. \Vith my construction, which is free from slit-like cavities and easily accessible for 11 thorough cleaning action in all its links, the

danger of infection is minimized.

The disassembling is performed'by turning the handles in adjacent position, in which position the operating rod can be taken out of its pivot engagement at 24, due

.to the freedom, in this position, of the screw 31 to pass through the slot opening 6. B swinging the disengaged rod end out of the sheath, the ball end 32 of the rod will gradually also disengageits notch 43 on the blade. with the result that, then, all parts are free to be disassembled. The assembly is carried out in the reverse order with the same ease.

The description, as well as the figures, -re fer to an embodiment of the invention preferred at the present time; however, there may be made changes in the construction without departing from the spirit of the invention, and in this respectI wish to be limprimary hole by termedia te frame of thebone parts rotatable relative having a pointed end for'a prima'ry independ- -ing edges ceived between ited I by the claims rather than by the description and drawing.

What I claim is: w 1. A surgical instrument for making an opening in thin osseous partitions located in.

body portions inaccessible for open operation, comprising a small body-insertable, shearslike 1 tool operated 1 by correspondmg moveone of the memindividually producing with open-shears a piercing a ction-,"-and 'both members having mating marginal portions with r shearing edges defining a: punch .hole

area for jointly enlarging, by closing the shears subsequent-to the piercing action,- said primary. hole by an' action of, substantially punching nature; 3 4

2.-A-:sur,'g1cal instrument for making an opening-in osseous partitions-adjacent the interior nose passages,-comprising aIframe for holding and f inserting theinstrument in the nose, an; operating handle movable with respect to the frame, and'an intermediate connecting element movable relative tothe inportion for transmitting rotary movements to the inserted operating end, said operating lend comprising a frame end portion for the support and the reception to be removed, and a blade, 'to said frame end portion,

ent piercing action I and inarginalportions defining a :punching 'area. for a'secondary punching action in cooperation with the matof the frame end portion.

3. A surgical instrument for. making an opening {in osseous'partit'ions adjacent the interior nose- :passages, .comprisinga frame for holding and inserting the instrument in the nose. anoperating handle movable with respect to the frame','-and 'anrintermediate connecting element movable relative to the intermediate frame portion for transmitting rotary movements to the inserted operating end, said operating end comprising an apertured tapering frame end portion for the .support on and the reception between its marginal walls of the bone partswto be removed. and asharp-ended blade conforming to said inner marginal walls and rota-table relative to them so as to be adapted "to be held either angularly to them for. an'independent primary piercing action or to he rethem in a secondary punching 210M011." I. 7

4. A surgical instrument for making an opening in osseous partitions adjacent-the interior nose passages comprising a frame-for holding and inserting the instrument in the nose, an operating handle movable with respect to the frame. and an intermediate connecting element movable relative to the intermedi'a'te frame portion for transmitting rotary movements to the inserted operating end, said operating end comprising an apertured tapering trame end :portion for the supportion and (the-reception between its marginal walls-of the bone parts to be removed and :a pointed, spoon-Shaped blade, znot-atable relative to said trams-end :portiom'with upstanding :and part or' their length indented marginal portions, forthis blade to :actias'ia primary piercing tool in a position angular "to the frame end :and as -,a secondary combined s'punching and cutting tool m cooperscam with (the inner edges :olf said marginal walls of the "frame.

5. Aesurgicalinstnument for making an iopening'i-n osseous partitions adjacent the intenior'rnose passages comprising a frame fior holding and inserting the instrument the nose, an operating handle movable with nespect'to the framqand sazneintermediate connecting element movable relative: to the intermediate frame portion :fer transmitting rotary movements to the inserted operating end, said operating end comprising a tapering, apertunedf-rame end portion with lateral walls for pivnt'ally receiwing between them, at rpontions concentrically enlarged on side with respect in q-mnchin'g inelation. which #blade has a generally spoon-shaped atoninwith sharply pointedtip and with upstanding marginal portions, whose edges :near the pivotal rend substantially conform. to the edges of said concentrically enlarged d'zrame portions and -,a.re' provided 'at this endwith sharpened teeth which also extend over part of its inter-mediate edgeportions, for said bla'de'to act as a primary piercing tool in angular position to the frameiend and as a secondary combined punching and cutting tool m cooperation with the corresponding-edges -of said lateral Walls of the frame end.

-6. A- surgical instrumentfor making an opening in :thin osseous partitions located in body port-ions'zinaccessible for open operation, comprising a small body-insertable, shears-like tool operated by corresponding movements of a pair of larger scissor handles connected to the tool by relatively mos-able, body-insertable connecting links, all of said various elements having inematic links of such construction as to' permit their assembling and disassembling in transverse direc tion to-their respective kinematic axis without the aid of separate joining elements, one of the members of said shears-like tool being pointed for individually producing with open :shears a primary hole by piereing=action, and both members having amating marginal :portions with shearing edges defining a punch hole iarea tor jointly enlarging, by closing the'shearssubsequent to the piercing action, said primary hole :an action of substantially punching nature.

the-other member hawmn gm ate the PiVO'DELl BXIS, a blade I opening-d minish ijiart itions "portions inaccessible fior open operation,-comtem-sees 57s A surg ioal-"instrument 'fior sinus operations and (the like including a shearing tool 'havingrtaworelatively movableshearinganemtberwbne anemiber hav ing piwotal 'studuneans,

hu-b bearing with a segment cut out so as to permit-the latter member at its h u b part to be' h'ooked on said stud means in position-formivotal movement between therbwo un'einbers, an operating rod for the pivoted h-ub' member h'aving an extension for 'siidable engagement with an open radial slot in the lint: member, said lrub -member ha ving =such -a radial slot located at such an angle thattlhe operuting rod extension holds the pivoted members in operating relation so long 'as s'ai'd exte-nsion is in said 81 at and means ,t p roc ute the OPG 'B Q'H rod in a soraight to causeone-sheanigng -1nember to pivet-ontlre other =tl-rrough the operating connection between the extension of said rod and-the hub bearingfi' *8. "The combinationof olainifi'witlrag uide sheath extending from one of the tool anembers *for the operating red and :a' stud and slot means to prevent relative tipping lnovements Within the range ofthe'woel members normal operation amdto 'permit such movement at point beyond such range.

"A surgical instrument for 'malringian -in' ?b'ody prising -a"--too=l with a 'part for first punching through such a partition and with a mating part for then receiving the ifirst part 'ivith a shearingaction to remove -a=portion of the partition'for the desired opening, said ,tool 'being operable first topunclr and 'then to shear without change of operating position except in the movement of the tool parts, by which movement the punching step carries both tool 'par ts "int-othe right position for the shearing step and the latter can follow withoutany delay-for instrument ad'fiusftment between the steps of suc'h'a-n operation, and means for manipulating said tool parts from a sufiicient distance to reach an accessible-pd sition for the surgeons hand.

10. A surgical instrument :for sinus oper ations and the like including aishearing tool having two relatively movable shearing members, one member-having pivotal stud means, the othermember having a hub bearing. with a sqfinent out so esin-Permit the latter mem or at itshub par'tto be hooked on said stud means, in position for pivotal movement between the two members, an operating rod forthe pivoted hub member having an extension for slidable engagement withian open radial s'lot inthe hub member, said hub member'having such a radial s'lot located at such an angle that'the operating rod extension holds the pivoted members in operating relation-so long as said extension is in said slot and means -to reoiprocatethe' operating rec. ina straight'line to cause one shearing memher to pivot on the other through the operating connection between the extension of said rod and the hub bearing, with a guide sheath extending from one of the tool members for the operating rod and a stud and slot means to prevent relative tipping movements within the range of the tool members normal operation and to permit such movement at a point beyond such range, and a handle member for said sheath, said handle member having a stud support, a second handle member having a hook-shaped recess to hang on the stud support for pivotal movement, said second handle member having a hook-shaped connection with the rear end of the operating rod separable by lifting the latter handle member away from its support on the first named handle member, all constructed and arranged so that all parts of the surgical instrument can be quickly dirassembled for cleaning purposes by unhooking such parts.

In testimony whereof I have aflixed my signature.

HOLLAND N. STEVENSON. 

